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De-escalation of anti-platelet therapy in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a narrative review

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Chinese Medical Journal 2019年第2期132卷 197-210页

作者： ya-ling han Department of Cardiology General Hospital of Northern Theater CommandShenyangUaoning 110016China.

Objective:Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor is the cornerstone of treatment in patients with acute coronary syndromes (ACS) and in those undergoing percutaneous coronary intervention (PCI).In current clinical situation, availability of different oral P2Y12 inhibitors (clopidogrel, prasugrel, and ticagrelor) has enabled physicians to switch among therapies owing to specific clinical *** optimum time, loading dose and interval of transition between P2Y12 inhibitors is still controversial and needs further evidence, switching between oral inhibitors frequently occurs in clinical practice for several *** sources:This review was based on data in articles published in PubMed up to June 2018, with the following keywords "antiplatelet therapy" , "ACS" , "PCI" , "ticagrelor" and "clopidogrel" .Study selection:Original articles and critical reviews on de-escalation strategy in ACS patients after PCI were *** of the retrieved articles were also screened to search for potentially relevant ***:Safety concerns associated with switching between antiplatelet agents, has prompted the use of clopidogrel for patients with ACS especially after PCI as a de-escalation *** considerations for de-escalating therapies in patients with ACS such as reducing dose of P2Y12 inhibitors or shortening duration of DAPT (followed by aspirin or P2Y12 receptor inhibitor monotherapy) as potential options are yet to be standardized and ***:Current review will provide an overview of the pharmacology of common P2Y12 inhibitors, definitions of deescalation and different de-escalating strategies and its outcomes, along with possible direction to be explored in de-escalation.

关键词： Acute coronary syndrome Antiplatelet therapy Clopidogrel De-escalation Ticagrelor

Individualized Antiplatelet Therapy： A Long Way to Go

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Chinese Medical Journal 2018年第12期131卷 1387-1389页

作者： ya-ling han Department of Cardiology The General Hospital of Shenyang Military Region Shenyang Liaoning 110016 China

Antiplatelet therapy is the cornerstone for the management of patients with coronary artery disease. In the past two decades, the study on individualized antiplatelet therapy has never been more prosperous accompanied... 详细信息

关键词： Acute Coronary Syndrome: Antiplatelet Therapy Cardiovascular Disease: Percutaneous Coronary Intervention

Impact of Baseline Bleeding Risk on Efficacy and Safety of Ticagrelor versus Clopidogrel in Chinese Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

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Chinese Medical Journal 2018年第17期131卷 2017-2024页

作者： He-yang Wang Yi Li Xiao-Ming Xu Jing Li ya-ling han Department of Cardiology General Hospital of Shenyang Military Region Shenyang Liaoning 110016 China

Background： There was still conflict on the antithrombotic advantage of ticagrelor versus clopidogrel among East Asian population with acute coronary syndrome （ACS）. We considered that the baseline bleeding risk might be an undetected key factor that significantly affected the efficacy of ticagrelor. Methods： A total of 20,816 serial patients who underwent percutaneous coronary intervention （PCI） from October 20l 1 to August 2014 in the General Hospital of Shenyang Military Region were enrolled in the present study. Patients receiving ticagrelor or clopidogrel were further subdivided according to basic bleeding risk. The primary outcome was net adverse clinical events （NACEs） defined as major adverse cardiac or cerebral events （MACCE, including all-cause death, myocardial infarction, ischemia-driven target vessel revascularization, or stroke） and any bleeding during l-year lbllow-up. Comparison between ticagrelor and clopidogrel was adjusted by propensity score matching （PSM）. Results： Among the 20,816 eligible PCI patients who were included in this study, there were 1578 and 779 patients in the clopidogrel and ticagrelor groups, respectively, alter PSM, their clinical parameters were well matched. Patients receiving ticagrelor showed comparable NACE risk compared with those treated by c[opidogrel （5.3% vs. 5. I%, P = 0.842）. Furthermore, ticagrelor might reduce the MACCE risk in patients with low bleeding risk but increase MACCE in patients with moderate-to-high bleeding potential （ticagrelor vs. clopidogrel, low bleeding risk： 2.5% vs. 4.9%, P = 0.022： moderate-to-high bleeding risk： 4.8% vs. 3.0%, P =0.225; interaction P = 0.021）, with vast differences in all bleeding （low bleeding risk： 1.5% vs. 0.8%, P =0.210： moderate-to-high bleeding risk： 4.8% vs. 3.0%, P = 0.002; interaction P- 0.296）.Conclusion： Among real-world Chinese patients with ACS treated by PCI, ticagrelor only showed superior efficacy in patients with low bleeding risk but lost its advantage in pa

关键词： Baseline Bleeding Risk: Clopidogrel Crusade Score: Efficacy: Ticagrelor

Cardioprotective effects of Guanxinshutong （GXST） against myocardial ischemia/ reperfusion injury in rats

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Journal of Geriatric Cardiology 2012年第2期9卷 130-136页

作者： Zhuo Llang Li-Feng Llu Tian-Ming yao Yu Huo ya-ling han Department of Cardiology Shenyang Northern Hospital Shenyang 110016Liaoning ProvinceChina Department of Cardiology Xijing HospitalThe Fourth Military Medical UniversityXi'an 710032Shaanxi ProvinceChina Department of lnstitute of Geriatric Cardiology Chinese PLA General Hospital 28 Fuxing Road100853 BeijingChina

Background The protective effects against reperfusion injury of cardioprotective drugs have recently been evaluated and found to be inadequate. Guanxinshutong （GXST）, a combination of the traditional herb and Mongolian medicine, is effective and safe in treating angina pectoris in clinical trials. We assess the cardioprotective effects of GXST against myocardial ischemia and reperfusion （MI/R） injury in rats and explore its possible mechanism. Methods Forty-five male Sprague Dawley rats were randomized into three groups： non-MlfR group （Sham, n = 15）, MUR group treated with vehicle （Control, n = 15） and MI/R group treated with GXST （Drug, n = 15）. MI/R was induced by ligation of the left anterior descending coronary artery （LAD） for 30 minutes, followed by 2/24 hour reperfusion in the Control and Drug groups. In the Sham group, the LAD was exposed without occlusion. GXST powder （in the Drug group） or saline （in the Control and Sham groups） were administered via direct gastric gavage from 7 day prior to surgery. Blood samples were collected from the carotid artery （10 rats each group） after 2 hours of reperfusion, to determine the levels of tumor necrosis factor-or （TNF-ct）, interleukin-1 ~ （IL-113）, interleukin-6 （IL-6） and intercellular adhesion molecule-1 （ICAM-1） using enzyme-linked immunosorbent assays. The animals were then sacrificed and the hearts were harvested for histopathology and western blot analysis. Infarct size was measured in the remaining five rats in each group after 24 hours reperfusion. Results GXST significantly decreased levels of TNF-ct, IL-1β, IL-6, ICAM-1, apoptosis index （AI） and infarct size. GXST also obviously inhibited nuclear factor kappa B （NF.r,B） activity when compared with the Control group （all P 〈 0.05）. Conclusions GXST is effective in protecting the myocardium against MI/R injury in rats. Its possible cardioprotective mechanism involves inhibition of the inflammatory response and apoptosis following MI/R injury.

关键词： I/R injury NF-r.B Inflammation Apoptosis Chinese herbal Guanxinshutong

Scientific statement of the Chinese Society of Cardiology(CSC) on using of renin angiotensin system blockers in patients with cardiovascular disease and COVID-19

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Journal of Geriatric Cardiology 2020年第5期17卷 241-242页

作者： ya-ling han Yu-Ming LI Chang-Sheng MA the Editorial Board of Chinese Journal of Cardiology 无不详 the Chinese Society of Cardiology

The coronavirus disease 2019(COVID-19), which is caused by SARS-CoV-2, has become a worldwide public health crisis. Published clinical data from China and other countries have shown a much higher risk of developing COVID-19 and dying from the disease among the elderly, especially among those who had preexisting hypertension, cardiovascular diseases(CVD) and diabetes mellitus[1].

关键词： Angiotensin converting enzyme Cardiovascular disease COVID-19 Scientific statement

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Chinese Medical Journal 2018年第12期131卷 1420-1429页

作者： Wen-Xia Fu Tie-Nan Zhou Xiao-Zeng Wang Lei Zhang Quan-Min Jing ya-ling han Department of Cardiology The General Hospital of Shenyang Military Region Shenyang Liaoning 110016 China

Background： Females with ST-segment elevation myocardial infarction （STEMI） have higher in-hospital and short-term mortality rates compared with males in China, suggesting that a sex disparity exists. The age of onset of STEM1 is ahead of time and tends to be younger. However, there are relatively little data on the significance of sex on prognosis for long-term outcomes for adult patients with STEMI alter percutaneous coronary intervention （PCI） in China. This study sought to analyze the sex differences in 30-day, l-year, and long-term net adverse clinical events （NACEs） in Chinese adult patients with STEMI after PCI. Methods： This study retrospectively analyzed 1920 consecutive STEMI patients （age 〈60 years） treated with PCI fYom January 01, 2006, to December 31,2012. A propensity score analysis between males and females was perfimned to adjust tbr differences in baseline characteristics and comorbidities. The primary endpoint was the incidence of 3-year NACE. Survival curves were constructed with Kaplan- Meier estimates and compared by log-rank tests between the two groups. Multivariate analysis was perforated using a Cox proportional hazards model for 3-year NACE. Results： Compared with males, females had higher risk profiles associated with old age, longer prehospital delay at the onset of STEMI, hypertension, diabetes mellitus, and chronic kidney disease, and a higher Killip class （≥3）, with more multivessel diseases （P 〈 0.05）. The female group had a higher levels of low-density lipoprotein （2.72 [2.27, 3.29] vs. 2.53 [2,12, 3.00], P 〈（1.001）, high-density lipoprotein （ 1.43 [1.23, 1.71] vs. 1.36 [1.11, 1.63], P - 0.003）, total cholesterol （4.98±1.10 vs. 4.70 ±1.15, t = -3.508, P 〈 0.001）, and estimated glomerular filtration rate （103.12 ± 22.22 vs. 87.55 ±18.03, t = 11.834, P〈 0.001 ） than the male group. In the propensity-matched analysis, being female was associated with a higher risk for 3-year NACE and major adverse cardiac or cerebral events compared w

关键词： Percutaneous Coronary Intervention: Prognosis Sex ST-Segment Elevation Myocardial Infarction

Long-term follow-up study of elderly patients with covered stent implantation after coronary perforation

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Journal of Geriatric Cardiology 2014年第3期11卷 218-221页

作者： Geng WANG ya-ling han Quan-Min JING Xiao-Zeng WANG Ying-yan MA Bin WANG Department of Cardiology Shenyang Northern Hospital Shenyang 110016 Liaoning Province China

ObjectiveTo evaluate the long-term efficacy of covered stent implantation in the treatment of elderly patients with coronary perforation while undergoing percutaneous coronary intervention （PCI）.MethodsFrom June 2004 to June 2012, our center has followed ten elderly patients （age≥ 60 years） who sustained coronary perforation during PCI. The major adverse cardiac events （MACE） were observed as well. The patients were advised to take 75 mg/day Clopidogrel for two years, and indefinite use of 100 mg/day enteric-coated *** out of the 10 patients aged from 60 to 76 years old （mean 68.6 ± 5.2 years） were male, four were female. The average diameter of the implanted stents was 3.3 ± 0.3 mm, and the average length was 22.1 ± 3.7 mm. All the ruptures were successfully sealed without intra-procedural death. The follow-up duration ranged from 0.6 to 67 months （mean 31.7 ± 24.5 months）. One patient died of multiple organ failure due to lung infection in 19 days after PCI; one died of cardiac sudden death in 13 months after PCI; one had angina pectoris in 53 months after PCI; one underwent multi-slice CT examination in six months after PCI, and no in-stent restenosis was found. The other four patients received angiography follow-up, and the results showed that three patients had no intra-stent restenosis, while one had left anterior descending （LAD） restenosis in the covered stent in 67 months after PCI. The in-hospital mortality was 10% （1/10）. The MACE rate in 12 months after PCI was 10% （1/10）. During the entire followed-up period, the restenosis rate in target vessels was 20% （1/5）, mortality was 20% （2/10）, and the MACE rate was 40% （4/10）.ConclusionTreatment of coronary perforation by using covered stents can achieve favorable long-term results; a two-year dual antiplatelet therapy （DAPT） after PCI can effectively prevent intra-stent thrombosis.

关键词： Coronary perforation Percutaneous coronary intervention Covered stent

Purification and functional assessment of smooth muscle cells derived from mouse embryonic stem cells

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Journal of Geriatric Cardiology 2013年第3期10卷 272-280页

作者： Xiao-Xiang Tian Jian Kang Cheng-Hui yan Kai Xu Jie Tao Gui-Tang yang ya-ling han General Hospital of Shenyang Military Region Department of Cardiology Chinese PLA Cardiovascular Research Institute

Objective To obtain a pure population of smooth muscle cells(SMC) derived from mouse embryonic stem cells(ESC) and further assess their *** A vector,expressing both puromycin resistance gene(puror) and enhanced green fluorescent protein(EGFP) gene driven by smooth muscle 22a(SM22a) promoter,named pSM22a-puror-IRES2-EGFP was constructed and used to transfect *** ESC(Tg-ESC) clones were selected by G418 and identified by PCR amplification of *** characteristics of Tg-ESC were detected by alkaline phosphatase(ALP) staining,SSEA-1 immunofluorescence and teratoma formation test in *** induction of SMC differentiation by all-trans retinoic acid,differentiated Tg-ESC were treated with 10 μg/mL puromycin for three days to obtain purified SMC(P-SMC).Percentage of EGFP+cells in P-SMC was assessed by flow *** of smooth muscle specific markers were detected by immunostaining and Western ***,migration and contractility of P-SMC were analyzed by growth curve,trans-well migration assay,and carbachol treatment,***,both P-SMC and unpurified SMC(unP-SMC) were injected into syngeneic mouse to see teratoma *** Tg-ESC clone was successfully established and confirmed by PCR detection of purorgene in its genomic *** Tg-ESC was positive for ALP staining,SSEA-1 staining and formed teratoma containing tissues derived from three germ *** retinoic acid induction,large amount of EGFP positive cells outgrew from differentiated *** days of puromycin treatment produced a population of P-SMC with an EGFP+percentage as high as 98.2%in contrast to29.47%of *** with primary mouse vascular smooth muscle cells(VSMC),P-SMC displayed positive,but lowered expression of SMC-specific markers including SM α-actin and myosin heavy chain(SM-MHC) detected either,by immunostaining,or immunoblotting,accelerated proliferation,improved migration(99.33 ± 2.04 vs.44.00±2.08

关键词： Differentiation Embryonic stem cell Phenotype SM22α Smooth muscle cell

Long-term follow-up of antithrombotic management patterns in patients with acute coronary syndrome in China

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Journal of Geriatric Cardiology 2020年第5期17卷 246-255,I0002-I0004页

作者： Xiao-Ning han Shu-Bin QIAO Jun-Bo GE ya-ling han Ji-yan CHEN Zu-Yi YUAN Bo YU Jie JIANG Yong HUO Department of Cardiology Peking University First HospitalBeijingChina National Center for Cardiovascular Diseases Fuwai HospitalBeijingChina Department of Cardiology Zhongshan Hospital Affiliated to Fudan UniversityGuangzhouChina Department of Cardiology the General Hospital of Shenyang MilitaryShenyangChina Department of Cardiology Guangdong General HospitalGuangzhouChina Department of Cardiology the First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina Department of Cardiology the Second Affiliated Hospital of Harbin Medical UniversityHarbinChina

Objective To describe the long-term antithrombotic management patterns(AMPs)and clinical outcomes of Chinese patients with acute coronary syndrome(ACS).Methods This was an observational,multicenter,longitudinal cohort extension study of Chinese patients who had completed the EPICOR Asia 2-year follow-up study post-hospitalization for an ACS *** in AMP and clinical outcomes for up to 5 years post-ACS event were *** Overall,2334 patients with ACS were enrolled at 49 *** mean age was 61.6 years and 76.3%were *** study end,2093 patients completed the 3-year *** baseline(2 years post-ACS event),72.4%of patents received one antiplatelet(AP)medication,with aspirin being the preferred one.A small proportion of patients(21.5%)was treated with two or more APs(2+AP),and even fewer patients(6.1%)did not receive any AP medication at *** study completion,the proportion of patients without AP therapy increased to 13.6%,while the percentage of patients on one AP and 2+AP decreased to 69.3%and 17.1%,***,a higher incidence of clinical events(composite of all-cause mortality,myocardial infarction,stroke)was observed for the 2+AP(13.2%)subgroup than for the no AP(10.5%)and one AP(8.6%)***,the 2+AP subgroup exhibited the greatest number of bleeding events,outpatient visits,and hospitalization *** myocardial infarction or stroke,bleeding events prompted an adjustment in *** Most patients in China received at least one AP medication up to 5 years after an ACS event.

关键词： Acute coronary syndrome Antithrombotic agents Antithrombotic management patterns Observational study Real-world